In Texas, Obama Calls on Perry to Expand Medicaid

During a visit to Dallas on Wednesday, President Obama called on Gov. Rick Perry to expand Medicaid under the federal Affordable Care Act and commended grassroots advocates for their work to educate uninsured residents on health insurance options under the new law.

"All of you understand that there’s no state that actually needs this more than Texas,” Obama said.

He emphasized that other states that chose to expand Medicaid have seen their rates of the uninsured decrease, such as Arkansas, where it dropped by 14 percent. “Your neighboring states have made that decision, because they look at it and say, 'This is a no brainer, why would we not want to take advantage of this?'”

The president spoke at Temple Emanu-El, a Jewish synagogue and member of Dallas Area Interfaith, a nonpartisan coalition of religious organizations that advocates for affordable health care options. He thanked Dallas Area Interfaith and other health care advocates for their efforts to educate Texans on the impact of federal health reform despite opposition from the state's Republican leadership.

"I just want all of you to remember, as challenging as this may seem sometimes, as frustrating as healthcare.gov may be sometimes, we are going to get this done," he said. "When we do, you’re going to have families all across this great state of Texas who are going to have the security and the well-being of high-quality, affordable health insurance, and that’s going to be good for business."

Under Perry’s leadership, Texas chose not to launch a state-run health insurance marketplace or expand Medicaid coverage to impoverished adults up to 185 percent of the federal poverty threshold, which Obama emphasized would leave a million Texans uninsured. Under the ACA, commonly known as Obamacare, the federal government would foot the bill for Medicaid expansion for three years, then reduce its share to 90 percent over 10 years. Perry has said that Texas should not expand a "broken" Medicaid system.

“President Obama deceived the American people by promising that anyone who liked their health care plan could keep it, but millions of Americans are now discovering that simply isn’t true," Perry said in a statement on the president's visit. "Now, he’s coming to Texas in a desperate attempt to salvage his ill-conceived and unpopular program from a Titanic fate by preaching expansion of the same Medicaid system he himself admits is broken."

Ultimately, Texas would have had to spend $15 billion to expand Medicaid over the next 10 years — spending that would've assured up to $100 billion in federal funds. Instead, the state Legislature approved a measure prohibiting the Health and Human Services Commission from even considering Medicaid expansion without its approval. The Legislature won’t reconvene until 2015.

“Folks who are complaining about how the website’s not working, and 'Why isn’t Obama fixing this,' and all of these people are uninsured, and yet they’re leaving a million people right now without health insurance that they could immediately fix," Obama said. "There’s not a lot of logic to that."

Texas has the greatest number of poor, uninsured adults — 1 million of 5.2 million Americans overall — who won’t have coverage available under the federal law because they live in states that chose not to expand Medicaid and they are too poor to qualify for tax credits to purchase a private plan.

Since its launch last month, the federal marketplace, healthcare.gov, has been plagued with technical problems that have made it difficult for Texans to shop for health plans and determine whether they qualify for tax credits to pay for the policies. Obama did not shy away from those problems on Wednesday, saying he has "not been happy" with the first month of the ACA rollout.

"Nothing drives me more crazy than the fact that right now there’s great insurance to be had out there, choice and competition, where people can save money for a better product, except too many folks haven’t been able to get through the website," he said.

Despite the website’s flaws, ACA advocates believe Texas has more significant health care problems that state leadership should focus on.

Texas has the highest rate of people without health insurance in the nation — 6.4 million Texans, roughly a quarter of the population, don't have coverage. Texas hospitals provide $5.5 billion in uncompensated care to uninsured residents each year, according to the Texas Hospital Association, raising both premium costs for private insurance plans and local taxes.

"Bringing the focus back to the importance of coverage is critical for not only the 6 million uninsured in Texas but also the taxpayers, privately insured and hospitals that are shouldering the costs of their health care,” Dan Stultz, president and CEO of the THA, said in a statement on the president’s visit. “Getting the marketplace enrollment processes fixed is essential but so is getting an insurance system in place that covers as many Texans as possible."

John Davidson, a health policy analyst at the conservative Texas Public Policy Foundation, says in a report that insurance premiums will be higher for plans offered in the federal marketplace, especially for younger people who are less likely to qualify for tax credits.

Although some health plans offered in the exchange will have higher premiums, proponents of federal health reform argue the comparison of pre- and post-ACA premium rates is misleading. Health plans offered in the marketplace are required to cover essential health benefits, such as prescription drug and emergency hospital care that some lower-cost private plans do not cover. The marketplace also requires insurance companies to offer relative premium rates based on age and household size and to accept everyone, regardless of pre-existing conditions, which some say has raised premiums for healthier, younger Americans while lowering premium costs for elderly, less healthy people.

A University of Texas/Texas Tribune poll released Wednesday found that most Texans do not approve of the Affordable Care Act, but that many find particular aspects of the law favorable. While 54 percent of those polled said they had an unfavorable view of Obamacare, three-quarters liked the idea of providing businesses tax credits to offer health insurance to employees, and 76 percent supported prohibiting insurance companies from denying coverage because of pre-existing conditions.

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